It means their medical funding is through the public coffers -- examples would include Medicare, Medicaid, VA, Tricare, etc.

I included that detail because it is a common observation and frustration that patients who are publicly funded -- especially those who do not bear any direct cost for the service provided -- tend to utilize them inappropriately.

The former managing partner at my law firm believes that the only thing that will stop the rising cost of healthcare is for the healthcare user to directly bear the cost of service. Until that happens, he postulates, it is to ones advantage to milk the system.

Just last night, we had a double bounce-back patient with simple NVD (ie, she saw the ER doctor 3 times in ONE SHIFT). Guess where she was from? Yep, the homeless shelter. There is literally no disincentive for her to come to the ER vs. going back to the shelter and toughing it out like 99% of people with NVD. In the ER (night shift), she gets a free bed, heated blankets, and, if lucky, IVs and medications to relieve her nausea. For any minor discomfort, she can show up and get all of the above. Hell, she even gets a private room to sleep in.

Cost to her for all these amenities? Same as the homeless shelter: Free. And she wasn't the only one who did the very same thing last night.

It contributes to the conservative (mis)diagnosis of the high cost of health care in this country. The standard conservative line is that people consume too much unnecessary health care, and if they had to bear some of the cost they would make better choices. There is a grain of truth to this, and this grain is all too obvious (and annoying) in the ER.

While I would agree that for things like this ER patients should have some disincentive to over-use it, this sort of thing is a drop in the bucket by a small segment of the population of our overall health care cost.

One CABG or valve job, or an angioplasty in a dialysis-requiring 85 year-old contributes more cost to the system than a whole ER's worth of lame visits in a year. The problem is the 5% of the population who generate 50% of the costs. How we can make those people price conscious is beyond me.

The obvious solution, to my mind, is a two-part one. First, make abuse of the ER and related emergency services an offense punishable by fine (with repeated abuse or refusal to pay becoming a crime), just as parking in front of a fire hydrant would be, only with much stiffer penalties. When you park in front of a fire hydrant, you prevent it being used for an actual emergency, thus a potent dissuading factor--getting a massive fine for so doing--is installed.

The second part, of course, would be to educate the public. I believe if you were to ask them, most people would say they knew that parking in front of a fire hydrant is prohibited by law. Yet so many human beings are seemingly oblivious to how very wrong it is to tie up doctors, nurses, and EMS workers for trivialities like pimples and stuck earring backs. If it were common knowledge that such behavior would get them in serious financial and, eventually, legal trouble, the problem would be greatly diminished.

Indigent offenders, particularly repeat ones, would not be able to pay such fines, obviously, but could be given the option of public service hours. And until broad awareness levels were reached, this would need to be stated upfront to anyone seeking emergency help, either by the 911 operator or the front desk at the ER.

(Please don't tell me there are already such laws in place but no-one enforces them!)

You People posting these stupid comments are just A** HOLES! You obviously have NO CLUE on what poverty is like as you snuggle into your down comforter after a few hours of blogging. I worked at a homeless shelter while I was in my third year; they had a clinic. The people in there were NOT just addicts/alcoholics. Due to a lack of help from society I encountered one family homeless from a furnace that went out in the middle of winter (would'nt it be cheaper for society if we set up a low interest loan for their furnace instead of creating 2 parents and 3 homeless kids... I also saw various other LEGIT reasons why people wind up homeless. If some of you get a few med mal cases you may loose 70% of what you are making now and then you can see how easy loosing your insurance can happen. What is wrong with giving someone with NVD a nice place to rest up for the night so that she can face the same crap that the American homeless go through in the morning? What is wrong with letting her use a clean bathroom to crap out the last of the USDA grade 'c' food she had last night? You guys have become so damn calous that you sound like a bunch of rich spoiled brats! When I read the other day that the USA was spending 25 Million of HIV medications for Congo (I think) I wanted to PUKE. It would be nice to set up more primary care centers for the poor and clean up some of the ratty homeless shelters so that people with NVD can go to a "sick room" for the night instead of the ER. If you guys are looking for more action, why dont you work in the ICU because if the people making these SELFISH posts are young, you have MANY years left of dealing with these things!!

Why is it that you think medicare is totally publicly funded? It is not. Not only have people paid into it all of their lives, they also make monthly premium payments. Hell, most even have secondary ins. that cost more than any premium they had during all of their work lives.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

All Content is Copyright of the author, and reproduction is prohibited without permission.